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Radiation Oncology • Palliation • Thoracic Malignancies • Stereotactic Body Radiotherapy • Rectal Cancer • General Radiation Oncology
Do you have a size criteria when treating lung oligometastases with SBRT?
Would you consider treating 3-5mm lesions with SBRT or wait until they are a certain size? I am concerned I will not be able to see them adequately on our 4D CBCT for SBRT.
Answer from: Radiation Oncologist at Academic Institution
A lesion 3-5 mm is difficult to characterize on PET, low yield for a biopsy, and non-specific, even if it developed in interval scans. Multiple 3-5 mm lesions could also be from an infectious/inflammatory condition. If the lesions are likely from cancer (i.e. new lesions with rising tumor markers, o...
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Answer from: Radiation Oncologist at Academic Institution
I would not treat newly noted 3-5 mm lesions upfront with SBRT given uncertainty as to whether these truly represent malignancy (in a patient without a cancer diagnosis), metastasis (if no prior diagnosis of metastasis), or whether these are truly oligometastatic lesions (in a patient with a known p...
Answer from: Radiation Oncologist at Academic Institution
I agree with the above. You need to first confirm that these small lesions are in fact malignant and not some other process. If you cannot confirm malignancy then you should not be treating.
If these are truly lung metastases, as mention above, there are some approaches that can be used...
Answer from: Radiation Oncologist at Community Practice
I think Dr Milano’s answer is good advice!
Albert Wiley MD PhD FACR,
US Navy Retired , Emeritus Prof / U of Wisc-